Abstract
Background
Data regarding incidence of ventricular (VA) and atrial arrhythmias (AA) in survivors after out-of-hospital cardiac arrest (OHCA) are scarce.
Purpose
To assess incidence of VA and AA in OHCA patients during long-term follow-up and to identify relevant predictive factors during the index hospital admission.
Methods
All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA from August 2007 to January 2019 and surviving until hospital discharge were included. Cox proportional hazard models and logistic regression analysis were used to investigate clinical variables related to the incidence of VA and AA.
Results
The final analysis included 201 patients. Mean age was 57.6±14.2 years and 168 (83.6%) were male. The majority of patients experienced witnessed arrests related to shockable rhythms (176, 87.6%). Thirty-six patients (17.9%) died after a median follow-up of 40.3 months (18.9–69.1), but only 4 presented another cardiac arrest. Eighteen patients (9.0%) suffered new VA and 37 (18.4%) developed atrial fibrillation/atrial flutter. History of coronary heart disease [HR 3.59 (1.37–9.42), p=0.010] and non-acute coronary syndrome-related arrhythmia [HR 5.17 (1.18–22.60), p=0.029] were independent predictors of VA during follow-up. The optimal predictive model for atrial arrhythmias included age at the time of OHCA, LVEF at hospital discharge and non-acute coronary syndrome-related arrhythmias (p<0.001).
Table 1 Variable Without VA With VA p value Age, mean ± DS, years 57.4±14.2 60.8±14.7 0.336 Male sex, n (%) 150 (83.3) 15 (83.3) 1.000 Coronary heart disease, n (%) 36 (20.0) 11 (61.1) <0.001 Cardiomyopathy, n (%) 27 (15.0) 8 (44.4) 0.006 Shockable rhythm, n (%) 157 (87.2) 16 (88.9) 1.000 ACS-related arrhythmia (Primary VF), n (%) 83 (46.1) 2 (11.1) 0.004 LVEF at hospital discharge (%) 47.5±13.9 38.3±16.5 0.010 Death during follow-up 32 (17.8) 3 (16.7) 0.603 Cardiac arrest during follow-up 2 (1.1) 2 (11.1) 0.042 CV hospital admission during follow-up 39 (21.7) 14 (77.8) <0.001 Atrial arrhythmias during follow-up 28 (15.6) 9 (50.0) <0.001
Figure 1
Conclusions
Despite low incidence of recurrent cardiac arrest, OHCA survivors face a high incidence of VA and AA. Several clinical characteristics during index hospital admission may be useful to identify patients at high risk.
3 - The importance of long-term follow-up after an out-of-hospital cardiac arrest. The experience of Pavia CARe.
